Graft-Recipient Collagen Lamellar Axis Discrepancy Is Compatible with Excellent Visual Acuity after Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To evaluate whether a discrepancy between the orientation of graft and recipient collagen lamellae can significantly limit the visual acuity after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: A multicenter cohort study of eyes that underwent DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy at Villa Serena-Villa Igea private Hospitals (Forlì, Italy) and at Santa Maria Nuova public hospital (Reggio Emilia, Italy), which were scheduled for a postoperative examination between July and September 2014. We have included eyes with a distance-corrected visual acuity of 8/10 or better, no ocular comorbidities, and a clear cornea. The main outcome measure was graft-recipient axis discrepancy of lamellar orientation around the visual axis as assessed by polarimetric interferometry. Results: Twelve eyes were included in this study. Eight eyes had a spectacle-corrected distance visual acuity of 8/10, 3 eyes had 9/10, and 1 eye had 10/10. In 8/12 (66.7%) eyes, 2 discernible axes of collagen lamellar orientation were identified and were all 30 degrees or more apart (range 30-90). In 2 eyes, only 1 axis was identified and in another 2 eyes, 2 axes 20 and 17 degrees apart were identified. The eye with 10/10 visual acuity presented a discrepancy of 17 degrees between lamellar axes. Conclusions: A discrepancy between the lamellar orientation of the graft and the recipient is compatible with excellent visual acuity after DSAEK.